This community-wide study will design, implement and evaluate interventions aimed at increasing the rates of quality-controlled mammography and breast physical examinations for women 50 years of age and over. The three populations targeted for interventions are: 1) physicians who refer patients for mammography -- family physicians, gynecologists; internists; and the nurse practitioner or head nurse in their practice; 2) radiologists who perform mammography; and 3) all women 50 years old and over. The primary intervention is a practice-based CME program for one-half of the randomly chosen practices in Family Medicine, Internal Medicine and Gynecology. The other practices in each specialty will serve as the control group. The intervention group will also be trained in the use of chart reminders which serve as a behavioral cue when used in the medical chart in their clinical practice. Secondary interventions will target: 1) radiologists and technologists who are targeted for improvement in the usage of equipment and for better patient access through cost reduction; and 2) patients over age 50, who are targeted to increase their awareness and knowledge of mammography and to increase their requests to primary care physicians for the clinical breast exam and screening mammograms. Analyses of the proposed interventions will rely on a randomized two-group design for evaluating the physician intervention, a quasi-experimental approach for evaluating the community-based cancer control education program, and a pre- and post-test design for assessing the intervention for radiologists. The overall goal of this project is to improve the rates of referral for mammography in the over age 50 women in the selected communities by at least 100% from the levels identified in the baseline year. We propose also to significantly increase the numbers of breast physical exams for this age group.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA045003-04
Application #
3187963
Study Section
Special Emphasis Panel (SRC (41))
Project Start
1987-04-01
Project End
1991-03-31
Budget Start
1990-04-01
Budget End
1991-03-31
Support Year
4
Fiscal Year
1990
Total Cost
Indirect Cost
Name
University of California Los Angeles
Department
Type
Organized Research Units
DUNS #
119132785
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Fox, S A; Stein, J A; Sockloskie, R J et al. (2001) Targeted mailed materials and the Medicare beneficiary: increasing mammogram screening among the elderly. Am J Public Health 91:55-61
Lane, D S; Zapka, J; Breen, N et al. (2000) A systems model of clinical preventive care: the case of breast cancer screening among older women. For the NCI Breast Cancer Screening Consortium. Prev Med 31:481-93
Fox, S A; Stein, J A; Gonzalez, R E et al. (1998) A trial to increase mammography utilization among Los Angeles Hispanic women. J Health Care Poor Underserved 9:309-21
Roetzheim, R; Fox, S A; Leake, B et al. (1996) The influence of risk factors on breast carcinoma screening of Medicare-insured older women. National Cancer Institute Breast Cancer Screening Consortium. Cancer 78:2526-34
Thomas, L R; Fox, S A; Leake, B G et al. (1996) The effects of health beliefs on screening mammography utilization among a diverse sample of older women. Women Health 24:77-94
Roetzheim, R G; Fox, S A; Leake, B (1995) Physician-reported determinants of screening mammography in older women: the impact of physician and practice characteristics. J Am Geriatr Soc 43:1398-402
Roetzheim, R G; Fox, S A; Leake, B (1994) The effect of risk on changes in breast cancer screening rates in Los Angeles, 1988-1990. Cancer 74:625-31
Fox, S A; Siu, A L; Stein, J A (1994) The importance of physician communication on breast cancer screening of older women. Arch Intern Med 154:2058-68
Fox, S A; Roetzheim, R G (1994) Screening mammography and older Hispanic women. Current status and issues. Cancer 74:2028-33
Kimme-Smith, C; Bassett, L W; Gold, R H et al. (1992) Testing mammography equipment: evolution over a 4-year period. Med Phys 19:1491-5

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